The American Heart Association is warning young ER patients about the risks of misidentifying the symptoms of cocaine use as heart attack symptoms. The results of some heart attack treatments in addition to cocaine can be fatal.
In an article published on Monday in The American Heart Association’s journal Circulation, Dr. James McCord and his colleagues confronted the issue of cocaine-related chest pain.
Cocaine is the second most popular illicit substance in the U.S. Its symptoms can be similar to those of a heart attack including shortness of breath, anxiety, chest pain, palpitations, nausea, dizziness and heavy sweating.
“Not knowing what you are dealing with and giving the wrong therapies could mean death rather than benefit,” said Dr. James Reiffel, professor of clinical medicine at Columbia University Medical Center/New York Presbyterian Hospital.
Some drugs used for heart attack patients can cause bleeding into the brain in patients whose blood pressure is high due to cocaine use.
Also, betablockers, that can lower blood pressure, have the opposite effect in cocaine users, raising blood pressure and squeezing cocaine-narrowed arteries.
Cocaine users visited the ER at an increase of 47 percent between 1995 and 2004 up from 135,711 to 199,198 according to the government’s Substance Abuse and Mental Health Services Administration.
According to the report, chest discomfort was reported in 40 percent of patients who appeared in the ER after using cocaine.
“The symptoms that they get with the cocaine are very similar to a heart attack,” said Dr. James McCord, who chaired the statement writing committee.
It is possible for cocaine to actually cause a heart attack. “By increasing heart rate, blood pressure, and contractility, cocaine leads to increased myocardial demand,” according to the article.
“Your heart rate goes up because your heart needs more oxygen, then it shrinks the arteries to the heart,” McCord said.
However, only 1 percent to 6 percent of patients with cocaine-associated chest pain actually have a heart attack, according to the guidelines.
The article suggests that all chest pain should be reported to physicians, but patients who use cocaine should be honest so they can be monitored using an electrocardiogram and other tests to rule out a heart attack.
“I think an ideal scenario would be someone whose job is to talk to them about this – explain the extent of the health problems, give them information about resources to help them quit cocaine,” McCord said.
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Columbia University Medical Center
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